Provider Demographics
NPI:1578648432
Name:MOTT, LORI L (MPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:MOTT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2215
Mailing Address - Country:US
Mailing Address - Phone:715-453-7600
Mailing Address - Fax:715-453-6403
Practice Address - Street 1:202 W MOHAWK DR
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-2215
Practice Address - Country:US
Practice Address - Phone:715-453-7600
Practice Address - Fax:715-453-6403
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6491-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40336300Medicaid